Abstract Details

Title The Predictive Value of Multimodal Intraoperative Neuromonitoring Techniques for Periprocedural Preventive Interventions during Carotid Surgery

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P15 - Poster Session 15 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-006

Background Carotid intervention for stenosis is performed for reduction of transient ischemic event or stroke risk. Intraoperative neuromonitoring (IOM), including electroencephalography (EEG), somatosensory evoked potential (SSEP), and near-infrared spectroscopy (NIRS) is used to minimize the risk of peri-operative neurologic events and may be used to guide operative decision-making. The utility of combined IOM methods is unclear. Therefore, we sought to investigate the value of multimodal IOM.

Objective To determine if the combination of EEG and SSEP monitoring has higher sensitivity in detecting intraoperative cerebral perfusion changes that may help guide surgical maneuvers

Design/Methods A retrospective review of all patients undergoing carotid intervention from January 1, 2012 to December 31, 2019 at a single academic medical center was performed. Patients with acute stroke undergoing catheter directed thrombectomy were excluded. Data collected included patient demographics, IOM parameters, surgical interventions, 30-day post-operative complications. Surrogate end-points of IOM change and hemodynamic interventions were also assessed. Efficacy and diagnostic value of each IOM modality alone and in combination were assessed using multivariable logistic regression.

Results A total of 409 carotid interventions in 311 patients meeting inclusion criteria were identified. Patients were 63.3% male/36.7% female, 83.4% white, 7.1% hispanic, 5.9% other. 162(39.6%) interventions were performed for ipsilateral symptoms including 111(27.1%) ipsilateral stroke, 91(22.3%) TIA. Use of a single versus multiple IOM modalities was not associated with a reduction in post-operative neurologic events. Changes in SSEP demonstrated a 2.97 odds ratio for neurologic events, though this was not statistically significant.

Conclusions Though neuromonitoring changes had higher odds of adverse events, surgical interventions were infrequent. The perioperative sample size is likely underpowered. It is unclear whether IOM had a significant impact on procedural modifications. Lastly, the lack of benefits of all modalities brings to question the cost of using all techniques.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Michael J. Schneck, MD, FAAN (Loyola University Chicago, Stritch School of Medicine)	An immediate family member of Dr. Schneck has received personal compensation for serving as an employee of Cellcarta. Dr. Schneck has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for HLT Medical. Dr. Schneck has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Miscellaneous legal firms. Dr. Schneck has stock in Baxter Labs. The institution of Dr. Schneck has received research support from NIH.